[Prognostic significance of intrapulmonary metastases in cases of surgically treated lung cancer].

OBJECTIVE

The aim of this retrospective study was to establish the prognosis in lung tumour cases in which resection was followed by synchronous or metachronous intrapulmonary metastasis.

METHODS

Between 1990 and 1999, 857 patients were operated on for primary lung cancer. Intrapulmonary metastases were observed in 21 patients. 11 cases were in stage III/B (on the basis of T4), and 10 were in stage IV (on the basis of M1). The histologic distribution of the primary tumours was 7 squamous cell carcinomas, 11 adenocarcinomas, 2 large cell carcinomas and 1 carcinoid. In 8 patients, histology demonstrated N1 or N2 lymph node metastasis. In 4 cases, there were more than one metastases.

RESULTS

The 5-year survival was 21%, and the mean survival time (MST) was 29.5 months. For both the 5-year survival rate and MST, there was significant difference between the lymph node negative (N0) and lymph node positive (N1/N2) patients (N-: 30.7%, N+: 0%, p=0.017, MST: N-: 38.3 months, N+: 10.5 months, p=0.014), according to the stage (III/B: 30%, IV: 11.1%, p=0.025, III/B: 40.1 months, IV: 17.8 months, p=0.04) and the number of metastases (1 metastasis: 26.6%, more than 1 metastasis: 0%, p=0.036, 1 metastasis: 35.2 months, more than 1 metastasis: 8.5 months, p=0.045). No significant difference was detected on the basis of histological type, pleural, vascular and lymphatic invasion. In patients where 1 metastasis was found within one lobe and there were no lymph node metastases, the 5-year survival rate was 42.8% and MST was 49 months. The complication rate was 28.5% and the 30-day mortality was 4.7% (1 patient). Reoperation was performed in 1 case, for thoracic wall haematoma.

CONCLUSION

Primary lung tumours giving intrapulmonary metastases, under certain conditions (lymph node negativity, 1 metastasis in the same lobe), can be operated on with good survival possibilities.